esophagus pathology
Terms
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- list the Congenital defects of the esophagus
- agenesis; atresia; fistulas
- list the acquired defects of the esophagus
- mucosal webs (proximal); schatzki’s ring (distal) varices (portal hypertension (40% mortality w/ rupture)
- list the lesions of esophagus related to motor dysphunction
- achalasia; hiatul hernia; diverticula; lacerations (Mallory weiss tear)
- esophagitis commun cause; histo appearance, complications
- acid reflux; inflammatory infliltrate w/ eosiniphils; complications include bleeding stricture and barret metaplasia; infections uncommon but seen in immunocompromised
- barret esophagus
- 11% of pts w/ chronic reflux will develop this. dysplasia of metalastic glandular mucosa may progress to adenocarcinoma (30 fold increased risk). high grade dysplasia progresses to invasive adenocarcinoma in 40%
- benign tumors of the esophagus
- usually mesenchymal; leiomyoma or other type of stromal tumor
- carcinoma of the esophagus most common types
- squamous cell and adenocarcinoma
- squamous cell carcinoma gross morphology
- may demonstrate a fungating exophytic tumor; 2 aflat diffuse neoplasm that infiltrates the wall of the esophagus; 3 an ulcerated excavated mass that grows deeply and invades adjacent structures such as the respiratory tract or aorta
- squamous cell carcinoma microscopy
- poorly differentiated (by degree of keratinazation in cytoplasm and presence or absence of intercellular bridges)
- squamous cell carcinoma prognosis
- five year survival rate of 25% because neoplasms often of advancee stage
- adenocarcinoma gross findings
- 80% in distal third of esophagus, 50% including proximal stomach; most are flat and ulcerated; 1/3 polypoid or fungating
- adenocarcinoma microscopy
- most arise in a background of barret esophagus with high grade dysplasia; usually “intestinal†type; may be composed of obvious glands or comprised of poorly formed tubules or signet ring cells; 75% have lymph node metasteses at time of diagnosis
- adenocarcinoa of esophagus prognosis
- <30% 5 year survival; esarly detection essential